Provider Demographics
NPI:1497024186
Name:LAMM DAVID EYECARE
Entity Type:Organization
Organization Name:LAMM DAVID EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-653-0118
Mailing Address - Street 1:3542A LOOP 306
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5944
Mailing Address - Country:US
Mailing Address - Phone:325-653-0118
Mailing Address - Fax:325-653-0118
Practice Address - Street 1:3542A LOOP 306
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5944
Practice Address - Country:US
Practice Address - Phone:325-653-0118
Practice Address - Fax:325-653-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-24
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093496001Medicaid
TXB148964Medicare PIN
TX00E97BMedicare PIN
TXT14315Medicare UPIN